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Home My WebLink About13-778 ��,� � CT'T'Y O�'DTAMOND BAR � `�"`"`-'�' � DEPARTMEIVT OF COMMUNITY&DEVELOPMENT SERVICE$ 21$10 Copley Drive,Diamond Bar,CA 9I7'65 {909}$39-7020 Fax(909)861-3117 Building I�spection Hotline(904)839-7027 PRESS ��''�� BUILDING PERMTT APPLICATION FIRMLY � .iOBSITE APpLICATIOt� PEAMiT -°� -�p P/C � A�➢RESS �ti`�..� ��l�l�� ,� . DAT� �� NUMBER �s °" f�� # �'i�- m ��.«i.� _ ��"'� lSSUE «� TYPE OCC ,PN- � LOT �"'� 7RAC7 '� ��"�� OAT� ""�� CO�ST. GRaUP p OWNER C�'i!a�Ae" �Y",� ..,, � ADpAESS �e9"�°-�d' .F��.� 3"'E;� �0.� ZbNINC, SEf$ACl(5 z C1TY Dl�l.t��:7 �a�� Z1P�1+�_4l� TEL.�a�';^�i4=��s'�f.� FRQNT RW f3 ' , � APPLICANT TEL. REAR ❑ ' � SIDEJ$IDE S7REET RIiV ❑ � ¢ CONTRACTOR c�f,o.'��;��s F,°� ��i'�� tic:�s"2� _...._ SI�E � � ADdRESS �'c.� i��C. �m7�� .--. q T�l.�'�.,��'-�o-°s�.`;�'�"� PROPOSED USE`� ��;�d i e; .�-r s�.r..�-�t �, c� � . � CI7Y�•� � ��s�r.� ZIP�1��-"� � � ARCWENG/ � DESlGNER uu ND.DWEL NQ. 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I$SUANCE � a-1w -1� "`��a°� SMIP ` �''�' p oATE: APPL;iCANT: �. � wAar�iN�:�a.tWa�Tos�cu�t�woRlc�As•coMvwsatioNcav�RqeEisuNvvyFut„nN�srw.i.�E ENERGYPIC � SU&lECTANEMPLOYERIQCREMiNPLPENALTIESpNOCNILFIFiE5l1PTOakEHl1N0AE�71i0USAtJ� EIJ�RGYP�RM�T Ooit,4Fi5(51ao,aon),!N AODITION 70YFIE COST OFCOMPENSArioN,oAMAGEs AS aH()VIDE�FOR IN � sEG71oN 37oB OF THE LABOR CODE,It17EREST,AN�ATTORNEt"5 FEES. � ;��.,�-� RETENTION F��: � CDNSTRUCT[ON LEN�ING AGENCY PR�-AlT FEE: � 1 HEREBY AFFlAM llNDER PENhLTY OF PERJURY TNAT THERE IS ACANSTALiCTION�EN�MG AGENCY �� . ��, �� F9fi THE PERFORMANCE OF7HE WORK FOR WH�CH THlS PERM1T15155UEll(SEC.soe7,CIV.C.j. � W � LENOER'S NPME � LENOER'SAO�RESS � 7'OTRL FEES ��`t � �' � ;C6pYEFY 7NAT I HAVE pEAd YH�S APPLIGATIONAI3o S7ATE 7HA7TH��oYE IkFOR1AATION IS CARAECT. � IAGREETOCOMPLYWS7HALLCITYAN�COUNT'fOR01NANCE5AN65TATELAWSREIA�NG7oBl11LbING � CtlNS7RUCT}ON,AN�HEFEBYALLTF30RIZEREPRESENTATNE50FTHISC011I3TYTOENiEAUPON7HE � ABQVE-MENTK)NEDPROPERTYFOAiNSPECTiONPUAPO5E5. GOMMENTS 0 � �' � � m PERMITTEE NAME(PRiNT� " � �� • � �$�f� {�j StGIJATUREOFPERMITTEE OA7E p�PT.ND. ��"� PA1D BY �� VALIQATION ��'�� z ~ WHITE—➢epaclmeni Copy,Y�LLflW—Flnance Copy,P1NK—Assessor Copy,GOEDEMRO�FiIa Capy,G�}�EN--AppllcanCs Copy _.. ...... .